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Depression and suicide understandably go hand in hand, which means that for many people, suicide prevention is an integral part of dealing with depression.

While not every depressed person attempts or commits suicide, most people who kill themselves are dealing with depression.

“Ninety percent or more of people who kill themselves have a mental disorder before the time of their death,” says Paula Clayton, MD, medical director for the American Foundation for Suicide Prevention in New York City. “Sixty percent have major depression. The link between depression and suicide is strong.”

Women are twice as likely to experience depression than men, but men are four times more likely to commit suicide. In general, men experiencing depression make up one of the highest risk groups for suicide, regardless of age, and the risk spikes even higher among elderly white men over the age of 85. Adolescents are also at risk, as suicide is the third leading cause of death for teens.

Factors at Work in Depression and Suicide

One serious risk factor for suicide is alcohol or substance abuse; about one in four people who commit suicide have alcohol in their bloodstream at the time of death, according to a recent study.

A recent significant loss, such as a job, a relationship, or a loved one

A sense of hopelessness

Easy access to weapons, especially guns

A tendency toward aggression

Poor impulse control

Suicide Prevention and Depression Treatment

“The only way to prevent suicide is to have an active, successful treatment,” says Dr. Clayton.

The steps to dealing with depression and preventing suicide include:

Understanding depression. Depression is a recurrent, treatable chronic disease, says Clayton, but it must also be taken seriously: “Doctors who treat depression have to be aware that the illness can be fatal.”

Taking prescribed medication. Antidepressants are very effective at helping people get back to the person they were, says Clayton. The key is to keep taking them until you are truly well, not just until you are feeling better. Combined with cognitive therapy (talk therapy), medication is the best approach to overcoming depression. Many types of drugs are available, including the most commonly used group of medicines called selective serotonin reuptake inhibitors (SSRIs).

Managing insomnia. The relationship between sleep and depression is complicated, but boils down to this: Depressed people need sleep to recover. It’s okay to take medication to get enough sleep if your doctor recommends it, but it’s not a good idea to use alcohol to try to sleep.

Ending drug or alcohol dependence. Effective substance abuse therapy needs to be part of the overall treatment plan.

Treating co-existing mental illness. Getting effective treatment for schizophrenia or any other mental health issue reduces suicide risk. In particular, bipolar disorder, characterized by cycles of both mania and depression, must be treated carefully and not misdiagnosed as simple depression.

Hospitalization if necessary. When someone dealing with depression starts to experience distorted thinking (like believing she is dying of cancer despite evidence to the contrary) or utter hopelessness, or is threatening suicide, it’s time for hospitalization. Even a few hours of treatment in the emergency room can make a difference, says Clayton, adding that in most states you can involuntarily commit a person to psychiatric care if she is in danger of hurting herself.

Staying with the depressed person. If you have reason to believe someone you love is seriously planning suicide, do not leave her alone. Stay with her and call for help.

Antidepressants and Suicide Prevention

You may have seen news linking the use of antidepressants to an increased risk of suicide. But while “there is a small group of people in whom there has been an increase in suicide ideation [thoughts] and attempts,” says Clayton, “the worst outcome of this news is that it might discourage patients and parents from using antidepressants.”

Clayton clarifies that depression has a built-in risk of suicide and that, for most people, antidepressants do not increase the risk of suicide; rather, they significantly improve quality of life.

There is currently a U.S. Food and Drug Administration (FDA) mandated “black box” label on SSRI drugs warning about the increased risk of suicide attempts in people under the age of 25 who take them. The FDA’s review concluded that these drugs also had no significant effect on preventing adult suicides. However, a recent study reviewing a large amount of data on SSRI antidepressants showed these drugs to have a strong protective effect against suicide in adults, though it did confirm the increased risk of suicide attempts in adolescents.

Because it is very difficult to predict which antidepressant will work for which person, patients and doctors need to be aware of certain red flags that signal a possible problem during the first weeks of treatment:

Increased agitation

Restlessness

Anxiety

If you experience any of these symptoms, contact your doctor immediately. Because of the link between depression and suicide, it is important to take the risk of suicide very seriously.